Rise In Chronic Diseases Research Articles

A Taxonomy for Mental Illness in Healthcare System

The rise in chronic diseases becomes strain in modern healthcare systems, some such disease is the mental illness. However, a solution is required to provide high quality care for the patient that is achieved through precision medicine. The precision medicine for mental illness disease is found to be taken care of because it treats the patient health by considering the individual profiles. The modern healthcare systems are encouraged to develop precision medicine to be used in the future and accessed anywhere in the world. This paper further provides a comprehensive survey of the state of art technologies of precision medicine approach for the mental illness disease. The aim of this research is to develop a taxonomy of mental illness disease by finding their symptoms along with genomes. The survey proposes a Medicare system should be developed for precision medicine considering deep learning techniques are the methodologies to classify the mental illness diseases for better accuracy and efficiency.

Lifestyle Medicine in Australia: A Potted History-So Far.

Lifestyle medicine commenced in Australia in response to the rise in chronic diseases following the epidemiological transition that began in the 1980s. Today, it is flourishing with an annual conference, a variety of multidisciplinary members, and a developed pedagogy for the "art-science."

An Ethically Mindful Approach to AI for Health Care

Health-care systems worldwide face increasing demand, a rise in chronic disease, and resource constraints. At the same time, the use of digital health technologies in all care settings has led to an expansion of data. For this reason, policy makers, politicians, clinical entrepreneurs, and computer and data scientists argue that a key part of health-care solutions will be artificial Intelligence (AI), particularly machine learning AI forms a key part of the National Health Service (NHS) Long-Term Plan (2019) in England, the US National Institutes of Health Strategic Plan for Data Science (2018), and China’s Healthy China 2030 strategy (2016). The willingness to embrace the potential future of medical care, expressed in these national strategies, is a positive development. Health-care providers should, however, be mindful of the risks that arise from AI’s ability to change the intrinsic nature of how health care is delivered. This paper outlines and discusses these potential risks.

Assessing the Adaptation of a Thai Version of the Ryff Scales of Psychological Well-Being: A PLS-SEM Approach

Psychological well-being plays a significant role in the prevention of chronic diseases. Southeast Asian countries could prevent a rise in chronic diseases by having access to reliable and valid tools to study psychological well-being and its impact on disease prevention. The Ryff Scales of Psychological Well-being (RSPWB) is a leading instrument for measuring psychological well-being and has been used in research in many countries. However, in Thailand, little research exists on psychological well-being and its relation to health and disease because versions of the RSPWB have not been translated and validated for the Thai population. This study aimed to assess the adaptation of a 54-item Thai version of the RSPWB. A research questionnaire, which included the 54-item RSPWB was translated, piloted, and completed by 1122 Thai undergraduate students. Analyses included the use of partial least squares, structural equation modeling (PLS-SEM)—a second-generation statistical technique for testing complex path models. Results showed a PLS-SEM measurement model with 23-items demonstrating good convergent and discriminant validity and reliability. The PLS-SEM structural model showed significant positive path coefficients from six factors (autonomy, environmental mastery, purpose in life, personal growth, positive relations with others, and self-acceptance) to the second-order factor of psychological well-being. Moreover, the 23-item Thai version supported the same six-factor structure of the original RSPWB. In conclusion, the adapted 23-item Thai version is shorter in length, easy to administer, has robust psychometric properties, and helps to fill the current lack of reliable and valid psychological well-being instruments available in Thai. Lastly, this study provides a model for other Southeast Asian countries to translate, pilot, and adapt the RSPWB into their local languages, which might help to facilitate further research in psychological well-being and its association with chronic diseases and health promotion.

An ethically mindful approach to AI for health care

Health-care systems worldwide face increasing demand, a rise in chronic disease, and resource constraints. 1 Martin GP Sutton E Willars J Dixon-Woods M Frameworks for change in healthcare organisations: a formative evaluation of the NHS Change Model. Health Serv Manage Res. 2013; 26: 65-75 Crossref PubMed Scopus (14) Google Scholar At the same time, the use of digital health technologies in all care settings has led to an expansion of data. These data, if harnessed appropriately, could enable health-care providers to target the causes of ill-health and monitor the effectiveness of preventions and interventions. For this reason, policy makers, politicians, clinical entrepreneurs, and computer and data scientists argue that a key part of health-care solutions will be artificial Intelligence (AI), particularly machine learning. 2 Chin-Yee B Upshur R Three problems with big data and artificial intelligence in medicine. Perspect Biol Med. 2019; 62: 237-256 Crossref PubMed Scopus (27) Google Scholar , 3 Harerimana G Jang B Kim JW Park HK Health big data analytics: a technology survey. IEEE Access. 2018; 6: 65661-65678 Crossref Scopus (47) Google Scholar AI forms a key part of the National Health Service (NHS) Long-Term Plan (2019) in England, the US National Institutes of Health Strategic Plan for Data Science (2018), and China's Healthy China 2030 strategy (2016).

A novel hybrid modeling approach for the evaluation of integrated care and economic outcome in heart failure treatment

BackgroundDemographic changes, increased life expectancy and the associated rise in chronic diseases pose challenges to public health care systems. Optimized treatment methods and integrated concepts of care are potential solutions to overcome increasing financial burdens and improve quality of care. In this context modeling is a powerful tool to evaluate potential benefits of different treatment procedures on health outcomes as well as health care budgets. This work presents a novel modeling approach for simulating different treatment procedures of heart failure patients based on extensive data sets from outpatient and inpatient care.MethodsOur hybrid heart failure model is based on discrete event and agent based methodologies and facilitates the incorporation of different therapeutic procedures for outpatient and inpatient care on patient individual level. The state of health is modeled with the functional classification of the New York Heart Association (NYHA), strongly affecting discrete state transition probabilities alongside age and gender. Cooperation with Austrian health care and health insurance providers allowed the realization of a detailed model structure based on clinical data of more than 25,000 patients.ResultsSimulation results of conventional care and a telemonitoring program underline the unfavorable prognosis for heart failure and reveal the correlation of NYHA classes with health and economic outcomes. Average expenses for the treatment of NYHA class IV patients of €10,077 ± €165 were more than doubled compared to other classes. The selected use case of a telemonitoring program demonstrated potential cost savings within two years of application. NYHA classes II and III revealed most potential for additional treatment measures.ConclusionThe presented model allows performing extensive simulations of established treatment procedures for heart failure patients and evaluating new holistic methods of care and innovative study designs. This approach offers health care providers a unique, adaptable and comprehensive tool for decision making in the complex and socioeconomically challenging field of cardiovascular diseases.

Effects of aromatherapy on stress, fructosamine, fatigue, and sleep quality in prediabetic middle-aged women: A randomised controlled trial

IntroductionAlthough there has been an overall increase in life expectancy, the rise in chronic diseases poses a threat to healthy life expectancy. In particular, individuals with chronic diseases such as diabetes, stress, fatigue, postmenopausal accumulation of abdominal fat, insulin resistance, and insomnia are likely to have a poorer quality of life. This study aimed to investigate whether aromatherapy (inhalation and massage) could affect levels of stress, blood glucose, fatigue, and sleep quality in middle-aged prediabetic women. MethodsThis was a randomized controlled trial. In this study, prediabetic middle-aged women, aged 40–65-years old, with a fasting blood glucose or HbA1c level of 100 mg/dL–126 mg/dL or 5.5–6.4%, respectively, were included. The experimental treatment consisted of direct inhalation of aroma essential oil and self-massage with 3% massage oil for two weeks, as prescribed by an international aromatherapist. To determine the effects of treatment, subjective stress, objective stress index, fructosamine, fatigue, and sleep quality were measured. Differences in stress response, sleep quality, and fatigue over time and between the two groups were analysed using repeated measures ANOVA and Student’s t-tests. ResultsSubjective stress did not significantly differ between the two groups after one week but became significantly different after two weeks (t=−3.78, p = .001). After the treatment, there were significant changes in fructosamine (t=−3.53, p = .001), fatigue (t=−4.12, p = .001), and sleep quality (t=6.27, p < .001). ConclusionThe study suggests that aroma inhalation and self-abdominal massage may help manage blood sugar, fatigue and improve sleep quality in pre-diabetic women.

Maternal and Infant Health in Abu Dhabi: Insights from Key Informant Interviews.

Consequent upon rapid development in Abu Dhabi, there has been a rise in chronic disease, the susceptibilities to which are influenced by events occurring in early life. Hence, maternal and infant health are key areas in public health policy. Following a study of maternal and infant health in a cohort of mothers in Abu Dhabi between 2002 and 2004, seven key informant interviews were undertaken to elucidate the study findings through the impressions of Emirati women in positions within the healthcare area—including ministries, hospitals, and universities in Abu Dhabi. Semi-structured interviews were based on five key questions that covered the cultural responsiveness of the maternal health services—breastfeeding, health education, and physical and recreational activity. The responses were analysed using a thematic content technique and indicated that the status of women, cultural beliefs and practices, limited health knowledge, and language differences between the local population, healthcare providers, and health promoting materials were important themes. The study highlighted areas for future research and policy, including the communication gaps between healthcare professionals and women, the influences of advertising and the media on health issues, heath education, and ways to increase women’s participation in physical exercise. It is vital to consider non-medical determinants of health alongside biomedical determinants, to help develop culturally appropriate health strategies for this population.

Multi-omic analysis in transgenic mice implicates omega-6/omega-3 fatty acid imbalance as a risk factor for chronic disease

An unbalanced increase in dietary omega-6 (n-6) polyunsaturated fatty acids (PUFA) and decrease in omega-3 (n-3) PUFA in the Western diet coincides with the global rise in chronic diseases. Whether n-6 and n-3 PUFA oppositely contribute to the development of chronic disease remains controversial. By using transgenic mice capable of synthesizing PUFA to eliminate confounding factors of diet, we show here that alteration of the tissue n-6/n-3 PUFA ratio leads to correlated changes in the gut microbiome and fecal and serum metabolites. Transgenic mice able to overproduce n-6 PUFA and achieve a high tissue n-6/n-3 PUFA ratio exhibit an increased risk for metabolic diseases and cancer, whereas mice able to convert n-6 to n-3 PUFA, and that have a lower n-6/n-3 ratio, show healthy phenotypes. Our study demonstrates that n-6 PUFA may be harmful in excess and suggests the importance of a low tissue n-6/n-3 ratio in reducing the risk for chronic diseases.

The impact of displacement on the social, economic and health situation on a sample of internally displaced families in Anbar Province, Iraq

Background: Internally displaced people in Iraq are still suffering because the solutions were not radical. This study aims to assess the impact of displacement on the socio-economic, well-being, and mental health status of internally displaced families in Anbar province, Iraq.&#x0D; Methods: A descriptive cross-sectional study was conducted from 3rd to 17th April 2017. Data was collected using a universal sampling technique. A total of 355 households interviewed with a modified questionnaire consisting of 26 close-ended questions related to the socio-economic, demographic, wellbeing, and mental health characteristics.&#x0D; Results: At the time of the study, about 55.5% of the surveyed displaced families have not returned home yet. Big families of more than seven members (59.4%) and residency in renting houses (82.8%) are two variables that may contribute to an economic burden. Mental health disorders such as depression and anxiety spread among 62.3% of surveyed families. Significant rise in chronic diseases from 64 (18.0%) cases before displacement to 102 cases (28.7%) after displacement. Few of them (21.6%) were able to access public health services. People who experienced violence are verbally abused at 52.1%. Lack of services (50.3%), the inability to repair the destroyed houses (26.4%), and the loss of houses due to complete destruction (23.3%) were the significant factors that inhibited families to return home back.&#x0D; Conclusion: Our findings indicate the need for urgent and strategic plans to improve the quality of logistics, health, and infrastructure services to motivate the displaced families to return back to their homes.

Turkish Neonatal Society guideline for the follow-up of high-risk newborn infants.

Developments in perinatal and neonatal care have increased the survival rate of high-risk newborns but led to a rise in chronic diseases seen in these infants. A significant number of them attend primary and secondary health care centers after discharge; however, there are very few standard protocols for the long-term follow-up of these babies. Therefore, we aimed to establish a follow-up guideline that emphasizes on universal screening schemes and takes into consideration national data. The guide presented here provides brief recommendations for physicians in light of evidence-based data for the follow-up of high-risk newborn infants. The steps taken to monitor and solve the problems of all high-risk infants may vary. We hope the use of such a standard approach in evaluating each infant in daily routine will improve the life quality of these high-risk infants.

Morbidity pattern, social safety net, and drug adherence level among geriatric patients attending in a health-care facility: A cross-sectional study.

INTRODUCTION:Financial support system available to geriatric populations affects their adherence level to the prescribed treatment leading to a rise in chronic disease burden.OBJECTIVE:The aim of this study was to ascertain the disease pattern, health expenditure, and adherence to the prescriptions among geriatric patients reporting to a hospital in North India.METHODOLOGY:This descriptive, cross-sectional study was conducted from July 2017 to June 2018. Patients who were 60 or above years in age, already diagnosed and were on treatment for more than 3 months were included in the study. A total of 310 patients were selected using convenient sampling method. Data were collected by a pretested and validated questionnaire.RESULTS:The mean age of the patients was 66.16 years ± 5.37 years (54.8% males). Monthly average family income was Rs. 15202.97 ± 1134.63. Overall, 25% of the treatment cost was met through various social schemes (52% = pension scheme, 32% of patients had no such schemes and only 2% through health insurance schemes). Rest was out-of-pocket expenditure. Common diseases were hypertension (60.64%), diabetes mellitus (35.8%), cancer (28.38%), and coronary artery disease (22.58%). More than half (52.9%) of the patients had two or more illnesses; about 35.8% of them were taking treatment for 1–5 years. Moderate adherence was observed among the majority of the patients. Statistically significant (P < 0.05) difference in treatment adherence to the prescriptions was observed.CONCLUSION:Geriatric patients had many chronic morbidities. They had high out-of-pocket expenditure and suboptimal financial support affecting their level of adherence to the prescriptions.

Global Sustainability Risk to India

Global economic risk management extends beyond India’s borders and will have severe impact if not properly addressed. According to the World Economic Forum (2016), “A global risk is an uncertain event or condition that, if it occurs, can cause significant negative impact for several countries or industries within the next ten years.” These risks include: ageing population, climate change, polarization of societies, rise of chronic diseases, rise of cyber dependency, rising geographic mobility, wealth disparity, shifts in power, and urbanization (World Economic Forum, 2016). This paper focuses on two primary sectors of the Indian economy: agriculture and water. In addition, discussions around the positive and negative aspects of global economic risks from natural disasters and the ways in which these risks have been accepted, avoided, mitigated or transferred in India. In conclusion, the paper presents a forecasting model on what to expect in these sectors over the next decade.

Observations on the health of infants at a time of rapid societal change: a longitudinal study from birth to fifteen months in Abu Dhabi

BackgroundRapid economic and cultural transition in the United Arab Emirates has been accompanied by a rise in chronic disease. Early childhood is known to affect health outcomes in adulthood. This prospective longitudinal study examined the general health of Emirati infants born in a government maternity hospital in the Emirate of Abu Dhabi in October 2002.MethodsOne hundred twenty-five women, who had recently given birth, were interviewed as part of a larger study encompassing a wide range of cultural, social, and behavioural aspects of health. They were then re-interviewed at three (n = 94), six (n = 59) and 15 months postpartum (n = 52). Data are presented using univariate statistics.ResultsIn this study seven infants (6%) were born prematurely and four infants (3%) were classified as small for gestational age, while 11 (9%) of the infants weighed less than 2500 g. Low birth weight infants (LBW) were significantly more likely to require treatment in the neonatal intensive care unit (OR = 30.83, p = 0.00). Iron supplementation during pregnancy was associated with fewer underweight infants (OR = 3.92, p = 0.042). No associations were found between infant birth weight and maternal age, age at marriage, consanguinity, education level, current maternal employment, parity, pre-existing anaemia or anaemia in pregnancy, diabetes, folic acid intake, multivitamin intake or infant gender.Maternally-reported infant health issues, vaccination, medication, breast-feeding and infant nutrition, and use of secure car seats are also reported.ConclusionsThe health of infants at birth in this UAE sample showed improvements compared to previous studies. The proportion of LBW infants is decreasing and continuing improvements in health care in the UAE are having a positive impact on infant health.

From local organisational harmonisation to Global change leader: a story of operational success

Introduction: (comprising context and problem statement) Like many countries, Ireland is facing a rise in chronic disease and the underutilisation of healthcare delivered to patients in the community. Services comprise publicly funded hospital and community services, and independent general practitioners. There is overreliance on hospital services and a lack of community services to provide alternative care. Short description of practice change implemented: CareDoc is a not-for-profit organisation and works as a service providing trusted third party, funded by item-of-service charges. It developed Community intervention team (CIT) services and offered them to move care from inpatient settings to deliver acute care in the community. A CIT is a nurse led service providing acute care to patients in the community, who otherwise would require hospitalisation. There is in house EHR support. Aim and theory of change: The aim is to provide appropriate patients with appropriate care in their community thus preventing unnecessary hospital admission or facilitating early discharge from hospital. The CIT uses strict clinical criteria to accept a patient into the service and must be avoiding a hospital admission or facilitating early discharge. Targeted population and stakeholders: The CIT is for patients over 16 years who require an acute clinical treatment that would usually take place in the hospital setting. Timeline: The first Caredoc CIT model of care concept and design was developed in early 2011 and the first patient accepted in the Carlow and Kilkenny area, covering a population of 145,659, in September 2011. Based on initial success, the Caredoc CIT model of care was extended in: - 2014 South Wicklow Population 118,379 - 2015 Waterford Population 127,807 - 2016 Tipperary Population 94,136. Highlights: (innovation, Impact and outcomes) The implementation required trusted partnership working with all stakeholders, engaging at an early stage, including management, clinicians, and allied health professionals from both primary and secondary care. The team developed and enhanced the relationships between the hospital, community and primary care settings to support patients and care delivery in the community. Comments on sustainability: The number of patients treated by the CIT service has increased annually with 2,866 treated in 2015 and 3,642 from January – October 2016. Comments on transferability: The Caredoc model of CIT has successfully expanded over 4 regions throughout Ireland. Conclusions and Discussion: (comprising key findings) The Caredoc model was included in “Lessons from transforming health services delivery: compendium of initiatives in the WHO European Region” and as a WHO reference site for Connected Integrated Health Service Delivery. Following on from this the Caredoc team have been asked by the WHO to lead a Global Community of Practice on Change Management. Lessons learned - Automatic buy-in not a given - Communication to all stakeholders is key - Key leaders and champions are vital - Do not encroach on clinical time - Arrange meetings to suit stakeholders - Fit-for-purpose IT (inter-operable real-time EHR) is essential - Mutual trust and added clinical value are key enablers

Grandmothers\u2019 perspectives on the changing context of health in India

BackgroundThe prevalence of obesity and other chronic diseases is increasing in India and around the world. As globalization and social changes are believed to be at the root of these epidemiological changes, these factors must be better understood. This study engaged older adults to gain an important perspective on globalization and health.MethodsA free-list instrument and a structured survey were developed and used to gather data on changes in diet, activity, and women’s roles from ten grandmothers in rural India.ResultsGrandmothers indicated that household chores and food preparation are less labor-intensive and time-consuming due to mechanization and the availability of prepared foods than a generation earlier. Families are more often eating food out, bringing prepared food home, and using ready-made food mixes; adolescents are continuing to eat meals at home, but now snack with friends outside the home more frequently.ConclusionsUsing both a free-list instrument and a structured survey, grandmothers were able to provide insights about the changing context of dietary patterns and family roles arising with globalization that may be contributing to the rise in chronic disease.

Basics in Human Evolution. Edited by Michael P. Muehlenbein. Academic Press. Amsterdam (The Netherlands) and Boston (Massachusetts): Elsevier. $120.00. xviii + 557 p. + 32 pl.; ill.; index. ISBN: 978-0-12-802652-6. 2015.

Previous articleNext article FreeEvolutionBasics in Human Evolution. Edited by Michael P. Muehlenbein. Academic Press. Amsterdam (The Netherlands) and Boston (Massachusetts): Elsevier. $120.00. xviii + 557 p. + 32 pl.; ill.; index. ISBN: 978-0-12-802652-6. 2015.Aryeh GrossmanAryeh GrossmanAnatomy, Midwestern University, Glendale, Arizona Search for more articles by this author Anatomy, Midwestern University, Glendale, ArizonaPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreThis is a laudably ambitious project. Although the title of the book indicates a focus on providing basic information about human evolution, in actuality it attempts to provide general reference to an audience interested in human evolution, modern human biology and genetics, human health and development, social organization, and human behavior—all viewed through a distinctly anthropological lens.The editor succeeded in herding 48 authors to produce 39 chapters organized into seven main parts. The first part includes only two chapters. The first chapter, introducing readers to the basic concepts of evolutionary theory and the facts of evolution, just might be the best chapter in the volume. Part II provides the primate background to human evolution, behavior, and anatomy. The introduction to the basics of primate behavior is particularly succinct and enjoyable. Part III covers the fossil record and phylogenetic hypotheses of early hominin through early to modern human evolution, and also addresses early hominin ecology, the origins of bipedal locomotion, and the evolution of tool use. Unfortunately, the chapters on hominin and human morphology and phylogeny follow a gradistic approach. For example, several authors lump Kenyathropus platyops and Australopithecus bahrelghazali with Australopithecus afarensis and prefer not to separate Paranthropus spp. from Australopithecus spp. This approach, which eliminates much of nuance of hominin evolution, is a poor choice for a book looking to provide a solid foundation into the current state of the field of human evolution. By contrast, the chapter on the origins of bipedalism provides a good review of different views about this crucial question in human evolution.From here on the volume enters its bioanthropological sections, which generally includes topics of more interest to the wider public. Part IV introduces readers to human population genetics, physiology, evolution of brain size and skin color, growth and aging, and reproductive ecology. The next part includes three chapters about modern subsistence modes. Part VI presents anthropological analyses of the relationships between changes in human environments and the rise of chronic diseases, infectious diseases, and pathogen evolution, human diet, and an introduction to paleopathology (how disease of the past are studied). This part addresses current health topics such as obesity, cardiovascular disease, and the rise of infectious disease. The final part explores the connection of biology and different human behaviors, including stress, love, war and paternal care, mating systems, cognition and language, moral systems and reciprocal behaviors, race and ethnicity, and the evolution of culture. The book ends with a good glossary and some excellent color images and figures.Although the volume is uneven, its strength is its many parts and broad spectrum of ideas. The book is a collection of idiosyncratic treatises gathered into loosely congruent sections that will allow any reader to pick and choose where and what to focus on. Thus, various chapters can form an excellent introduction to different graduate courses in bioanthropology and the volume would fit on the shelf of any anthropology or general university library. Previous articleNext article DetailsFiguresReferencesCited by The Quarterly Review of Biology Volume 92, Number 1March 2017 Published in association with Stony Brook University Article DOIhttps://doi.org/10.1086/690866 For permission to reuse, please contact [email protected]PDF download Crossref reports no articles citing this article.

Inglês

Introduction: The aging of the world population is a theme emphasized in scientific research generally, this fact placesBrazil among the countries that will be affected significantly by the aging population, since, combined with this process, implies onthe rise of chronic diseases, loss of physical and mental abilities. Objective: To identify, through a literature review, the importance offunctional capacity, nutritional status and level of physical activity on the health of the elderly population. Methodology: The studyincluded original and review articles related to the topic, published in English, Portuguese and Spanish, from 1987, selected in thedatabases SciELO, Lilacs, PubMed and BIREME is using three sets of intersecting terms of bibliographic search, functionalcapacity, level of physical activity and nutritional status. Results: The described search strategy enabled locate 42 articles on thesubject studied, 11 of them reviews, 16 books, 2 dissertations / theses and 9 publications federal. Conclusion: Wear exposedhighlight it is important to employ health indicators able to identify elderly in the risk group of the above indicators in order to guideactions to maintain the functionality, keeping them in the community as long as possible with maximum independence and qualitylifetime.

Engineering performant, innovative and sustainable health systems

Background : In a time of growing health expenditures and inefficiencies, ageing populations, rise of chronic diseases, co-morbity and technical evolutions, there is a worldwide quest for performant, innovative and sustainable health systems that are, a.o. effective and cost-efficient, patient-centric and co-creative and able to deal with the growing society dynamics. Problem statement : Effectively implementing strategic initiatives that tackle these challenges appears a frightening task since the majority of implementations fail. Current approaches and frameworks addressing organizational changes are fragmented, heterogeneous and mostly descriptive. We aimed to design and develop a more prescriptive, holistic and integrated approach. Literature review : Methodologies, governance techniques, approaches and other “best practices” from a.o. the manufacturing and generic services sector are being applied to health and health care services. We observed the existing organizational science literature and found that most existing approaches are not, or inadequately concerned with design and many share the same underlying mechanistic characteristics: strongly management and planning oriented, focus on internal control that apparently should secure success of future health system organizations. Theory : We summarize the needed concepts and theoretical background of the Enterprise Engineering discipline, including Enterprise Ontology (the implementation-independent essence of organizations) and the DEMO methodology, Enterprise Governance and the Normalized Systems theory. Method : We used the Design Science Research Methodology (DSRM) and demonstration is based on real health reform proposals and (fictitious) anecdotal scenarios. Discussion : Formal publication of architectural principles and requirements according to the Enterprise Architecture discipline aids in: - correlating enterprise design principles to areas of concern, and further to strategic choices, norms and values, and policies; - providing coherent and consistent attention to the various implications of architecture; - defining a coherent and consistent set of follow-up activities defined as key actions (studies, pilots, projects) to enable the architecture to be effective; As main characteristics of using Enterprise Ontology, we demonstrated: - it ensures completeness in unambiguously discerning all activities required to deliver health services; - it aids considering and comparing different implementations of these activities and their executing actor roles in health organizations, people and automation; - the models can be used in “just in time, just enough detail”-mode; - creating the models is possible with an attractive return-on-modeling-effort (ROME); Different strategic choices, areas of concern, as well as functional and constructional requirements are not met at the implementation-independent level. In order to perform optimally and to implement changes successfully, these organizations must operate as a unified and integrated whole, which can only be achieved through deliberate Enterprise Development and Enterprise Governance. Furthermore, we show it is possible to integrate compatible and relevant analysis techniques and improvement/quantification methods to prepare a better, more objective and more “calculated” change reform proposal, or to assess the impact of an existing one. Conclusion: Lack of enterprise integration and coherence has been identified as one of the core reasons for not successfully operationalizing strategic initiatives. In view of the several enterprise aspects, a design approach must be able to address all aspects. Realization must be intentionally designed, as virtually all causes for poor enterprise performance are systemic. Also, a fundamentally different perspective on governance is essential for: (1) addressing enterprise dynamics, complexity and associated uncertainty; (2) iteratively, evolutionary, and emergent development of strategic initiatives and their operationalization and (3) realizing a unified and integrated enterprise organization and operation. The Enterprise Engineering paradigm and integrated with compatible analysis techniques, improvement and quantification methods; provide a solid foundational theory and methodology, different and unified approach for integrating several enterprise aspects that would otherwise be treated incoherently and inconsistently, causing failures in strategic initiative implementations. In relation to the theories underlying our proposal, we experienced: (1) an initial steep learning curve and emergence of the EE Discipline; (2) that not all activities in organizations are transaction based as they experience emergent properties, and can therefore not be expressed in the current EO theory, e.g. strategy development, decision making processes, knowledge workers or enterprise design itself; (3) that the understandability of the produced EO models by the stakeholders must not be taken for granted; (4) a strong desire for an (unattainable) fully codified method. During our research, we also experienced a strong pull towards the financing and expenditure context, both in literature interviews, reform proposals, demonstrative cases and interviews. Another phenomena, was the lack of public availability and scarcity of up-to-date, reliable and comparable data and measures to work with. We have high confidence in the application of our proposal to address problems of inefficiency and unsustainability in health system organization using a deliberate enterprise development and governance approach.

The heterogeneity of the Case Manager role in Spain. A methodology for its conceptualization

Summary : This study aims to analyse and define the role of the case manager (CM) in Spain. The qualitative technique of semi-structured interviews together with the literature review technique have been chosen for the information gathering process. This study constitutes the first of the several stages of a broader research project whose ultimate goals are to create a Network of Integrated Care professionals (NIC) and to reach some conclusions about the CM role in Spain. The rise of chronic diseases, partly caused by demographic changes and increased longevity, requires the development of new strategies on health and social care policies. High levels of dependency associated to chronic patients imply that health care and social problems need to be addressed through coordinated actions of these two public services. The implementation of the CM seek to respond to this need. CM for chronic patients usually undertake coordination tasks within different levels of the health care system and between the health care and social systems. This coordination substantially enhances the continuity of care. Case management enables the integration of the social and health care systems and, therefore, the integrated and needs-centered health care service that patients require. The definition of the role played by the CMs is highly ambiguous; pluripathologies management, single collective (fragile elderly) and single disease management, to name only a few, are amongst them. Nevertheless, there have been also identified some of the CM most basic elements including; patients identification, problems and need assessments, care plan setting, etc. Methodology : Through the usage of an explorative methodology, the numerous roles played by the CM in Spain will be identified and classified. More concretely we will be looking at the main similarities and differences, and analysing impact results. Ultimately patterns and potential scenarios will be considered. This methodology is composed by various stages; 1- Semi-structured interviews and literature review techniques will be used to gather information from professional interviewees (professional profiles, services offered, population target, etc). In addition, a theoretical framework will support the information provided by these professionals. The objective of this first stage is to obtain an initial document which describes and simplifies the complexity that characterises the practices related to the CM. 2- Focus group; the next step will involve naming a group of professionals from the social and health care sectors to discuss the different ideas appearing in the initial document. The purpose of this stage is to reach some conclusions on the CM different realities. The resulting document will ultimately serve as a basis from which the NIC will be created. Bearing in mind that the ultimate goal of this study will only be reached in the mid-term, the main purpose of this initial paper is to elaborate a document which will serve as the basis for following stages of the research project. Preliminary results : The CM is characterised by a significant lack of homogeneity in its implementation, both within and between Spanish regions. - Despite the CM presence in most Spanish regions, its characteristics and functions vary considerably. The main differences are found in the professional profile, services offered, and duties carried by the CM, and its relationship with inner and outer professionals. These variances occur within and between regions. - The different CM functions will be categorised using the five-stages model (case finding, assessment, care planning, care coordination and case closure) based on Ross.S et al (2011). CM functions have been intuitively obtained by applying an explorative methodology in a number of CM experiences. - In Spain it is possible to observe different levels of policy development regarding the CM role (design, pilot, implementation process...). For instance, in Catalonia, Castile y Leon and the Basque Country, the role of the CM has been considerably successful whereas in Navarra no implemented practice, related to this specific actor, was found. Similarly, whilst a number of experiences where the CM has been especially dedicated to coordinate a specific treatment process, others have been implemented, in a broader sense. - Furthermore, the consequences resulting from these practices widely differ depending on the context and, a part of in the case of Andalucia, there are no major publications on the consequences of these practices. As an example, in Andalusia the CM has supposed a sort of driving force for change towards a broader model of integrated care where new roles and new ways of care management have arisen.